Shi Lin-Hong, So Ho, Lam Steven Ho Man, Li Tena K, Li Edmund, Szeto Cheuk-Chun, Tam Lai-Shan
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong.
JC School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong.
Ther Adv Musculoskelet Dis. 2024 Nov 29;16:1759720X241303314. doi: 10.1177/1759720X241303314. eCollection 2024.
Hypertension (HTN) is the most important modifiable risk factor for the development of cardiovascular events (CVEs). Patients with axSpA are also associated with an increased risk of future CVE.
To ascertain whether baseline early-stage HTN is a predictor of future CVE in addition to inflammation in patients with axial spondyloarthritis (axSpA).
A retrospective cohort study.
Patients with axSpA were recruited from 2001 to 2017. Patients with at least 2 years of follow-up and without prior CVE were divided into three groups according to the calculated mean blood pressure (BP) over the first 2-year follow-up period (adjusted mean BP) (⩾140/90, 130-139/80-89, and <130/80 mm Hg). They were followed from baseline until the end of 2020 or the occurrence of a first CVE. Multivariate Cox regression analyses adjusting for baseline and time-varying variables were used to assess the relationship between mean BP and CVE.
Out of the 437 patients fulfilling the inclusion criteria, 49 (11.2%) and 132 (30.2%) had an adjusted mean BP ⩾ 140/90 and 130-139/80-89 mm Hg, respectively, and 256 (58.6%) were pre-HTN. After a median follow-up of 12 (7-18) years, 56 (12.8%) CVEs were documented. The incidence rates were 21.4, 14.2, and 5.9 per 1000 patient-years for the three groups, respectively. Baseline adjusted mean BP of 130-139/80-89 mm Hg was independently associated with the occurrence of CVE after adjusting for the baseline covariates as well as time-varying high inflammatory burden.
Baseline-defined early-stage HTN carries excessive risk of developing CVE which may be due to untreated inflammatory burden. Early antihypertensive therapy should target this BP level to minimize their future risk of CVE.
高血压（HTN）是心血管事件（CVE）发生最重要的可改变风险因素。轴性脊柱关节炎（axSpA）患者发生未来CVE的风险也会增加。
确定在轴性脊柱关节炎（axSpA）患者中，除炎症外，基线期早期高血压是否为未来CVE的预测因素。
一项回顾性队列研究。
2001年至2017年招募axSpA患者。将至少有2年随访且无既往CVE的患者，根据首个2年随访期内计算的平均血压（BP）（校正平均BP）分为三组（≥140/90、130 - 139/80 - 89和<130/80 mmHg）。从基线开始随访至2020年底或首次发生CVE。采用多变量Cox回归分析，对基线和随时间变化的变量进行校正，以评估平均BP与CVE之间的关系。
在437例符合纳入标准的患者中，校正平均BP≥140/90 mmHg和130 - 139/80 - 89 mmHg的患者分别有49例（11.2%）和132例（30.2%），256例（58.6%）为高血压前期。中位随访12（7 - 18）年后记录到56例（12.8%）CVE。三组的发病率分别为每1000患者年21.4、14.2和5.9例。在校正基线协变量以及随时间变化的高炎症负担后，基线校正平均BP为130 - 139/80 - 89 mmHg与CVE的发生独立相关。
基线定义的早期高血压具有发生CVE的过高风险，这可能归因于未治疗的炎症负担。早期抗高血压治疗应以该血压水平为目标，以将其未来发生CVE的风险降至最低。
